P - 81135REQUEST FOR ELECTRICAL INSPECTION
�'�5C7-311 � Minnesota State Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
�� (651) 642-0800 www.electricity.state.mn.us � �`
Home Duplex Apt. Bldg. Other: New Atldn
Commerciat Industrial Farm Remotl Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y,
N3P SAVER'S 8WITCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformeNGenerator
Sign / Outline Ltg. Xfmr'.
Alarm/Remote Contro�
Swimming Pool
Irrigation Boom
Special Inspe�tip►rt ,� ,
Fee - This Inspection Reauest will not be accented without the correct fee.
0 to 200 Amps 0 to 100 Ai
Above 200 Amps Above 100
INSPECTOR'S USE ONLY
I herebvi certifv that I
Investigative F�� c� I��^ �' — o j
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF, NQ.T_ �fJMi'.A.F.�F� :�A4�.T+�
..... ............................... .
OFFICE U8E ONLY This request vaid 18 months from validation date printed in fhis box.
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*08583114*
PLEASE PRINT OR TY
Re� �%� at9� Rough-In inspection required? O Yes ❑ No Inspection Other Than Rough-In: 0 Ready Now � Will Call
You must call the inspector when ready! Date Ready:
I, 0 licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY